The only matter of the heart that matters

It was an Oprah show, of all things, which convinced me that even when it comes to disease and death, the odds are stacked against women. No, this was not about men having more money for treatment or families spending more on treating men-folk and boy children.

It was simpler. It was about misdiagnosis. And the fact that it was unintentional that made it scary.

The show had clips of a young man and a young woman describing identical symptoms of a heart attack to the same set of physicians. While all the physicians asked the man to get screened for heart disease, three out of four misdiagnosed the women’s symptoms as signs of anxiety and sent her away with a prescription for Prozac.

Little has changed since then, with women both erred against and erring.

Most women mistakenly think they are armoured against heart disease by the hormone estrogen. Though estrogen protects young women against heart trouble, high blood pressure and diabetes make them lose this advantage rapidly after the age of 40. Newer studies show that women also have genetic disadvantages, such as lower levels of good cholesterol (high density lipoprotein or HDL) and smaller arteries, which stops blood flow even if the blockage is small.

Then, there are women-specific risk factors such as hypertensive pregnancy disorders, gestational diabetes, polycystic ovary syndrome, menstruation disorders, premature menopause, early menopause and severity of menopausal symptoms, all of which make women rapidly lose their protective benefits.

Even bad lifestyles show a strong gender bias. Smoking puts women at a much higher risk of heart attacks than men, more so if the woman is young and using contraceptive pills. A 2010 survey in France showed that 73% of women under age 60 who had heart attacks smoked. Smoking makes the blood clot and causes artery-blocking plaques to form, raising heart and stroke risk.

Detecting heart disease in women has always been more difficult because women’s symptoms are often not typical — instead of angina (burning sensation or pain in the chest), they are more likely to just feel breathlessness, giddiness, fatigue, pain in the middle of the chest, neck or left arm, or suddenly being out of breath. More often than not, women themselves dismiss their symptoms as general uneasiness. And Oprah showed that even when they describe them to physicians, they are not taken seriously.

There’s even a diagnostic bias. Traditional heart function tests such as the treadmill test are less sensitive for women and are more likely to give false results, forcing many cardiologists opt for early angiography, cardiac CT scans and stress echocardiography for acute diagnosis. Two studies at Johns Hopkins showed that risk-factor scoring for heart attacks misses one-third of women who are at risk. The Hopkins findings, which appeared in the American Heart Journal, were critical assessments of the Framingham Risk Estimate (FRE), which estimates your chance of having a heart attack in the next 10 years based on whether you smoke, your age, your blood pressure and blood cholesterol readings.

Heart disease kills more women than men in developed countries, with women accounting for 55% of the deaths in Europe, shows European Cardiology Society data. Yet there’s still a disturbing gap in the knowledge, understanding, and general awareness of heart disease in women, in both women and medical professionals. Till the doctors get wiser, it’s for women to stay healthy by exercising regularly, eating healthy, avoiding stress, maintaining a normal weight and not smoking. Women over 40 years should get their cholesterol, blood sugar and blood pressure checked regularly, especially after menopause when the heart risk rapidly rises.